Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E-4683 | CA |
N | 213ES0103X | Foot & Ankle Surgery | PO00000826 | WA |
NPI | 1013110121 |
---|---|
Provider Name | Dr. Dianne Ilene Mitchell |
First Address | Sacramento, CA 95816-7058 |
Second Address | Sacramento, CA 95816-7058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 26/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4283MI | BLUE SHIELD # VM (01) | WA |
8493975 | (05) | WA |
US9237053 | AETNA PCP PIN VM (01) | WA |